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Abstract
Background Our Community Public Health System established a protocol for biological treatment of rheumatoid arthritis in May 2011.
Purpose To perform a Budget Impact Analysis folowing the introduction of a protocol for biological treatment (BT) in rheumatoid arthritis (RA).
Materials and methods Patients with AR treated with BT and the associated cost were analysed, before and after protocol implementation (second semester of 2010, 2011 and 2012). Protocol levels: 1st line: infliximab or a subcutaneous tumour necrosis factor inhibitor (etanercept or adalimumab), considering the evidence for the same effectiveness and safety; 2nd line: tocilizumab or abatacept or rituximab; 3rd line: golimumab or certolizumab. After negotiations with manufacturers, our health system decided to start treatment with etanercept as the less expensive TNF inhibitor. Collected data: number of patients per drug, average cost/patient in a semester and compliance rate according to European public assessment reports (EPAR) posology. The cost/patient indicator was calculated by adjusting treatment time to six months.
Results RA patients account for 48% of patients with rheumatic diseases treated with TB. The number of RA patients treated rose over the three periods studied, 179 patients in 2010, 211 in 2011 and 236 in 2012; etanercept use increased from 35% to 40%. Average cost in AR patients was: 5,620 € in 2010 second semester, 5,458 € in the same period of 2011 and 5,252 € in 2012. The number of patients increased by 32% from 2010 to 2012, but the cost rose by only 23%. The etanercept compliance rates according to EPAR posology were 92%, 89% and 89% in 2010, 2011 and 2012 respectively.
Conclusions Implementation of a protocol and dose optimisation allowed savings of 700 € per patient/year comparing 2012 and 2010. The establishment of a protocol prioritises the use of lower-priced drugs and enables centralised negotiating. The goal of efficiency is to optimise the cost opportunity: more patients treated with less impact on the budget.
No conflict of interest.